States look to Medicaid to curb maternal mortality

kieferpix via Getty Images

 

Connecting state and local government leaders

Expanding Medicaid postpartum care from 60 days to 12 months gives states more tools for addressing rising maternal death rates.

For many, expecting a baby is a dream come true. Pregnancy conjures images of baby showers and gender reveal parties, Facebook-worthy photos and a nursery filled with colorful toys and children’s books.

But pregnancy and childbirth can have complications too. From delivery issues like hemorrhaging, torn muscles and other injuries sustained during and after birth, many women find themselves in need of additional health care and services long after giving birth. 

While the Medicaid program has historically covered pregnancy-related health needs, coverage only lasts60 days postpartum. That was the case until a 2021 provision under the American Rescue Plan Act allowed states to extend the coverage period to 12 months through a state plan amendment. The extension option, slated to sunset after five years,was made permanent under last year’s passage of the Consolidated Appropriations Act. 

The state plan amendment option gave states a “much easier” pathway to expand coverage, said Taylor Platt, health policy manager at the American College of Obstetricians and Gynecologists. “I think that’s one of the reasons why from 2021 and onward, we’ve seen more and more states take up the option.” 

In fact, 49 states have moved to lengthen postpartum coverage under Medicaid, which finances four in 10 births across the nation. Even states that have not expanded Medicaid under the Affordable Care Act, such as Alabama, Mississippi and Texas, have extended postpartum care coverage. 

State Medicaid agencies have potential to see cost savings under this model, Platt said. Increasing access to preventative postpartum services can reduce the need for emergency room visits from the many patients who avoid routine health care to cut down on medical expenses. 

Montana’s Medicaid postpartum coverage, for instance, includes depression screening for caregivers, among other recommended procedures for pregnancy-related care, said Laurie Zephyrin, senior vice president for Advancing Health Equity at the Commonwealth Fund. Montana received federal approval for its state amendment plan late last year.

Plus, postpartum services apply to a small section of the overall population, “so it’s relatively low cost compared to Medicaid budgets overall,” said Edwin Park, research professor at Georgetown University’s McCourt School of Public Policy.

Idaho is the latest state to increase Medicaid pregnancy-related coverage to a full year with the March 25 passage of House Bill 633, which takes effect July 1. That leaves Arkansas as the sole holdout state. From 2018 to 2020, Arkansas had the highest maternal mortality rate in the U.S. 

During a roundtable of policymakers last month, Arkansas Gov. Sarah Huckabee Sanders said Medicaid postpartum coverage extension is unnecessary because alternative insurance options exist for individuals, such as fee-for-service Medicaid, the state’s ARHOME Medicaid expansion program or subsidized health plans from the federal health care marketplace, the Arkansas Advocate reported.  

Maternal health overall is receiving increased attention in a post-Dobbs world, Park said, “which I think is affecting how policymakers are viewing the postpartum [coverage] option, particularly in more conservative states that have had some of the most onerous restrictions on abortion.”

“I also think that because maternal mortality rates are steadily increasing in the United States, with really stark racial differences among Black and indigenous birthing people, [postpartum coverage expansion] has become a forefront when looking at health policy,” Platt said. “State lawmakers want to try and find ways to solve the maternal mortality crisis.” 

Indeed, the U.S. maternal mortality rate grew from 17.4 per 100,000 live births in 2018 to 23.8 in 2021. For Black women, the mortality rate was more than double (69.9 per 100,000 live births) that of white women (26.6 per 100,000 live births) in 2021. 

Maternal health can remain compromised for weeks, even months after delivery as well. Issues like postpartum depression, digestive problems and pain or infection can surface long after childbirth, so extending Medicaid coverage from 60 days to 12 months “is key to accessing service,” Platt said. “When you have coverage, and especially in the Medicaid population, you’re more likely to seek care, especially preventative care.” 

Whether an individual wants to see a primary care physician, a cardiologist or seek behavioral health services, for instance, “having that insurance coverage is key … to address [postpartum] issues from the ground up, instead of waiting until an emergent situation,” Platt said. 

“Coverage before, during and beyond pregnancy is really important for addressing the whole continuum of care,” Zephyrin said. While there is a cost to expanding Medicaid services, “there is a cost to not being able to access care,” she said. “There is a cost to mortality.”

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.